Can lithium be given to a patient with Mb Meniere?/nTreatment with lithium is considered in a patie

Fråga: Can lithium be given to a patient with Mb Meniere? Treatment with lithium is considered in a patient with Mb Meniere. The patient is afraid that lithium treatment will worsen his dizziness.

Sammanfattning: Dizziness is a common side effect of lithium that usually abates with time. Lithium therapy appears not to worsen symptoms in patients with Mb Meniere.

Svar: Lithium is known to cause dizziness and has been reported in 5-16 percent of lithium treated subjects (1). Dizziness is a concentration dependent adverse effect that often appears early after initiation of lithium therapy and usually abate with time (1, 2).

Common symptoms in Mb Meniere are episodic vertigo (motion-sickness), hearing loss, nausea and tinnitus. Mb Meniere is thought to be caused by a dysfunction in the endolymphatic system (3).

It has been hypothesised that lithium could be used to treat Mb Meniere due to its stabilising effect in the inner ear (4). This hypothesis has been tried and in the first, open, trial 70% of lithium treated patients showed improvement in symptom severity and attack frequency. All subjects who responded to lithium treatment (n=21) in that study was then recruited to another, blind, study comparing the effect of placebo with the effect of lithium. Subjects received lithium for 6 months and placebo for 6 months and no difference in effect between placebo and lithium was observed (5). Another study in 29 patients with Mb Meniere reported similar results. Seventy-three percent of the subjects reported improvement irrespectively of therapy (lithium or placebo) (6). No evidence that lithium should worsen the frequency or severity of symptoms in Mb Meniere patients has been found.